HISTORY

 

When schools closed in New Jersey in mid-March, no-one could have predicted the fall-out of being quarantined at home and the effect of adjusting to online learning.  There are no mental health statistics which are ready to give us an accurate impact of COVID-19 on our children and teens.  However, we can anticipate some of the issues which might arise by looking at the impact of previous events in history, such as the Spanish Flu of 1918, and subsequent epidemics including polio, HIV, Ebola, MERSA, SARS, and Swine Flu.  Research on these earlier health and economic disasters have taught us about human resilience.  However, such research has also documented significant deterioration in the population’s mental health (Dooley & Catalano, 1984).  For example, the Great Depression of the early 30’s caused a massive upswing in suicides (Beaglehole, Mulder, Frampton, 2018). I believe it is safe to say that we can reasonably expect the same increase in depression, anxiety, substance abuse and PTSD disorders associated with COVID as we would following natural disasters, such as earthquakes, hurricanes, tsunamis, floods and acts of terrorism such as 9/11 (Beaglehole, Mulder & Frampton, 2018)

 

“We have previously experienced naturally occurring and human-made disasters, but nothing in our lifetimes compares to the scope of the COVID-19 crisis ………If similar patterns hold for the COVID-19 pandemic, long after the physical threat of infection has subsided, psychological … (the) behavioral effects of persistent distress within the general population-will be a major consequence”.  (Lieberman & Olfson, 2020)

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ANXIETY & STRESS

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Even in the best of situations, all teens experience some anxiety in the form of worry, apprehension, dread, fear or distress. Anxiety is a feeling of apprehension or fear. Sometimes we don’t know the source of the uneasiness and this can lead to feeling even more distressed.  A certain amount of anxiety and worry is a necessary evil and part of the human condition.  Growing up we learn to listen to anxious feelings to inform us about choices.  We learn to manage anxiety as a healthy signal to our brain that we might need to protect ourselves or avoid a dangerous situation altogether.   Stress, on the other hand, can come from any situation or thought that makes you feel frustrated, angry, nervous, worried, or even anxious. The experience of stress can also vary from one person to another.

The worst kind of stress is unexpected, protracted, relentless and perceived as insurmountable. It is made even worse when this type of stress is combined with the absence of responsive and consistent caretakers.  If there aren’t any adults or services to support the young person during the stressful period, the long-term effects can be extremely damaging. 

A final note about stress and human development.  Recent research suggests that a child’s response to stress is not just calibrated in the first two years of life.  There is evidence that teens have another opportunity to “wire-up” their sensitivity to stress for a second time during and after puberty.   This second chance for neural pathways, however, could make things either better or worse, depending on the environment. The sustained stress of COVID-19 does not show signs of letting up and for many students, the outlook of school and college is, at best, very ambiguous.  Therefore, the stress system of these young people could remodel for increased vulnerability, setting the stage for potential mental and physical health diseases.  https://www.developmentalscience.com/blog/2019/5/7/our-teens-are-more-stressed-than-ever

 

Typical reactions to COVID-19 include:

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• Feeling stressed or overwhelmed, frustrated or angry, worried or anxious

• Feeling restless, agitated, on ‘high alert’ or unable to calm down

• Being teary, sad, fatigued or tired, losing interest in usually enjoyable activities or finding it difficult to feel happy

• Worrying about going to public spaces, becoming unwell or contracting germs

• Constantly thinking about the situation, unable to move on or think about much else

• Experiencing physical symptoms such as increased fatigue or other uncomfortable sensations

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(https://www.mentalhealthfirstaid.org/2020/04/tips-to-help-teens-cope-during-covid-19/)

 

TEEN STATISTICS PRE-COVID

 

The American Psychological Association (APA) periodically surveys for stress in the American public, and since 2013, “Generation Z” (born after 1995) have reported higher levels of stress than adults. In the 2018 APA survey, Gen Z’s have reported worse mental health and higher levels of anxiety and depression than all other age groups. 

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• 56 percent of Gen Z’s who are in school say they experience stress at least sometimes when considering the possibility of a shooting at their school

• 68 percent of Gen Z’s feel very or somewhat significantly stressed about our nation’s future

• 91 percent of Gen Z’s between ages 18 and 21 say they have experienced at least one physical or emotional symptom due to stress in the past month compared to 74 percent of adults overall

• 1 in 5 teens has had a serious mental health disorder at some point in their life

• 50% of all mental illnesses begin by age 14, and 75% by the mid-20s

• Suicide is the second leading cause of death for 15 to 24-year-olds.

• More than 81 percent of Gen Z’s between the ages of 18 and 21 report money as a source of significant stress

• 25 percent of Gen Z’s say they would not know where to find help if they had a problem with drugs or alcohol

• One newly mentioned stressor, personal debt (such as student loans and credit card debt), is a significant source of stress for more than two in five adults (42 percent)

 

 

TEENS & COVID-19

 

How has Covid-19 impacted our teens and young adults?  Perhaps the most immediate impact was the effect of schools and colleges closing.  In addition to being institutions of learning, schools and colleges are major hubs for sports, socializing, clubs, special interest groups, as well as support services and counseling.   

 

It is easy to overlook the essential role that school services play in the mental health of this population.  An analysis of the 2012 to 2015 NSDUH found that among all adolescents who used any mental health services in the year, 57% received some school-based mental health services (Ali, West, Teich, Lynch, Mutter, & Dubenitz, 2019).  This begs the question, where has this age group gone for help during COVID-19? 

 

Developing social connections and a sense of identity are two of the most critical developmental tasks during the teen and young adult years. Erik Erikson wrote his groundbreaking work, Identity, Youth, and Crisis, about identity in adolescence.  Additionally, a teen’s focus is expanded as they turn their attention to the larger world, moral issues and their future successes.  All of this goes on with a brain that is still developing higher levels of abilities, such as judgement, decision making and self-regulation.  COVID-19 has the potential to seriously undermine this developmental stage which requires an abundance of different social interactions and relationships.  This should be a time period when teens can make relationships and connections with role models outside of the family.  Instead of becoming larger and opportunistic, the world of youths has become smaller and more restrictive.

 

Here is a list of some of the stressors which teens have reported to me during their psychotherapy sessions over the last 5 months.  See how many you would have predicted.

 

• Increase in family conflict and stress of living in close quarters with family members

• Family stressors such as financial hardship, family illness and loss of loved ones

• Difficulty in handling the lack of structure and the loss of daily routines

• Constant changes to curriculums and teaching schedules

• Difficulty transitioning to online learning

• Loss of in-person relationships with teachers and counselors

• Loss of in-person mental health and awareness programs

• Loss of sports practices, games, talent identification and sports days

• Loss of class events and field trips

• Loss of major rites of passage such as Proms, Graduations and Awards ceremonies for Seniors

• Loss of music and arts performances and exhibitions

• Inability for Juniors to visit colleges

• Shelter-in-place-fatigue

• Confusion and stress over colleges starting back in the Fall.

• Loss of summer jobs

• Loss of summer camps and activities

• Loss of vacations and planned travel

• Lack of personal contact with friends

• Complete absence of social life, parties and dating

• Boredom

• Anxiety about getting COVID-19 or about a family member getting sick

• Anxiety about reentry into school

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TEENS & YOUNG ADULTS - HOW CAN YOU TAKE CARE OF YOUR MENTAL HEALTH ?

 

Here are some recommendations compiled from several sources to help teens cope with the stress and anxiety of COVID-19

 

1. RECOGNIZE THAT YOUR ANXIETY IS A NORMAL REACTION TO COVID-19

 

Anxiety is a normal reaction to something as stressful as COVID-19.  It is the brain’s natural response to protect you and keep you from danger.   Sometimes the brain works overtime imagining something that hasn’t happened yet and planning a defense strategy.  This causes anxious reactions way ahead of when they “might” be needed.  Try to differentiate between a reaction to something which is going on right now and a reaction to something that is way out in the future.

“I have spent most of my life worrying about things that have never happened” – Mark Twain.

 

In a study about worrying (Goewey, 2014):

 

1. 85 percent of what subjects worried about never happened

2. for the 15 percent of subjects who’s worry actually happened, 79 percent of them discovered either they could handle the difficulty better than expected, or the difficulty taught them a lesson worth learning

3. This means that 97 percent of what you worry over is not much more than a fearful mind punishing you with exaggerations and misperceptions

 

If you are going to read about COVID-19, which is completely understandable, make sure that your information is coming from reliable resources such as UNICEF and the World Health Organization’s websites.  Avoid news stories and websites which sensationalize the news and limit the amount of time you spend watching social media and the news. 

 

If the source of your anxiety is about developing symptoms, make sure you talk to an adult or health practitioner.  “Keep in mind that illness due to COVID-19 infection is generally mild, especially for children and young adults,” says Dr. Lisa Damour  New York Times

March 11, 2020.  “There are many effective things we can do to keep ourselves and others safe and to feel in better control of our circumstances: frequently wash our hands, don't touch our faces and engage in social distancing.”

 

2. “THE COURAGE TO CHANGE THE THINGS I CAN”

 

Perhaps you have heard the “Serenity Prayer” written by the American theologian Reinhold Niebuhr (1892–1971). It is commonly quoted as:

 

God grant me the Serenity
To accept the things I cannot change,
Courage to change the things I can,
And the Wisdom to know the difference.

 

Feeling out of control is a common theme during the COVID-19 crisis.  With so many restrictions and regulations, it is easy to feel as though you have lost control of your life and have no idea what the future has in store.  The antidote to feeling out of control is to focus on those things which are still under your influence.  Albeit the list is shorter, but there are some ways you can distract yourself with things that are still under your jurisdiction. Watching shows on Netflix, reading a book, submitting schoolwork in a timely manner, brushing your teeth, playing your favorite video game – all of these activities share in common that you are in control of them.

 

3. STAY CONNECTED SAFELY

 

Adults and parents really need to understand how important it is for you to stay connected to your friends.  I often ask my younger clients “whatever would we have done if the pandemic was, say, 20 years ago?”.  Despite the fact that you can get very creative when you need to, I can’t begin to imagine how you would have faired without social media and video platforms.  My only recommendation is that you don’t overdo the time on screens and maybe even come up with a limit that you put on yourself (before your parents put one on you) so maintaining your control over something that is highly important to you.  Also read the article on Zoom Fatigue.

 

 

4. PRACTICE RANDOM ACTS OF KINDNESS

 

There is nothing quite like doing something for someone else to create that feel-good-all-over feeling that you have brightened up their day or made their life a little easier.  When we see someone else smile or experience happiness our own neural circuitry mirrors their neural circuits and we feel their feelings!   When we can’t do anything else, we can still practice being kind to one another.  This is particularly true when people share different levels of comfort with social distancing and quarantine.  Don’t judge people if their ideas are different than your own. Instead be kind and compassionate and focus more on your own boundaries.  Read more about why kindness is so good for you.

 

When remembering to be kind to others, don’t forget to include yourself with self-kindness.  Self-care and self-compassion are extremely important during this stressful time.  Read more about being kind to yourself.  

 

5. NOTHING TO IT BUT TO GO THROUGH IT

 

You are probably experiencing a wide range of emotions or feelings.  Some of these feelings might include fear, anxiety, resentment, anger, blame, or disappointment.  It is important to remember that it is inappropriate to judge feelings.  They aren’t “right” or “wrong” - they just “are”.   Furthermore, it is also healthy to feel them.  Trying to avoid emotions can actually create more problems than experiencing the feelings themselves.  For example, drinking alcohol or using marijuana might change how you are feeling in the moment, but when you sober up you now have two problems:  the one you were trying to avoid and recovering from using an illegal substance to excess!   

 

“The best way to deal with … disappointment  [is to] let yourself feel it. When it comes to having a painful feeling, the only way out is through. Go ahead and be sad, and if you can let yourself be sad, you’ll start to feel better faster.” Lisa Damour, 2020.

 

 

TO PARENTS & CARETAKERS OF TEENS &

YOUNG ADULTS

 

As many of you reading this may already know, raising teens and launching young adults are two tasks which are already difficult.  Some of the difficulties include:

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1. setting limits without being over-controlling;

2. encouraging without being judgmental;

3. supporting without over-caretaking;

4. creating space without losing connection. 

 

None of these challenging questions became any easier to answer when COVID-19 became central and foremost in everyone’s minds. 

 

Here are some guidelines which take into account the developmental stages of adolescence and young adult.

 

1. EMPATHY - “FOMO” IS A REAL THING!

 

Fear Of Missing Out and being excluded is a serious concern for young people.  The main developmental tasks of this age group require widening relationships outside of the family and practicing independence.  Therefore, it is particularly hard for them to restrict their social contacts and in-person meetings.  It is made even harder when the responsible young people among them see the “Highlight Reels” of their peers not following social-distancing rules and abandoning their safety in lieu of having a good time with their friends.  What is more, the part of the brain which mediates judgement and impulse control is still under construction, making it hard for the young adults and teens to moderate their emotions and behaviors.  Empathy towards your teen/young adult is particularly important and can go a long way towards helping them experience you as someone who is understanding of their situation.  Help them to come up with creative ways to be with their friends without compromising their health and safety.  

 

2. COPING WITH “SHUTDOWN FATIGUE”

 

“Shutdown Fatigue” is also a real thing.  It is a kind of “crispy” feeling bordering on “burnt-out.”  It includes tiredness, frustration, low tolerance, impatience, and a serious drive to do something different.  Try to take this into consideration during family times and look for opportunities to do fun things together and apart. Try to appreciate that individuals vary in the amount of alone time they need.  Introverts and extraverts differ from one another in the amount of human interaction they need.  Extraverts usually experience feeling “re-energized” when they are around others and can feel depleted when they are left alone without social contact.  Introverts, on the other hand, are likely to feel their energy being drained in social situations and they tend to leave social get-togethers feeling tired and depleted. Conversely, introverts find their time alone to be restorative and re-energizing.  It is important to consider the varying needs of family members by understanding the impact of the shutdown on different personality types.  Interestingly, extraverts are doing slightly better than introverts during the shut-down (Travers, 2020) since they have been found to be more optimistic and have a broader network of social contacts than the introverts.

 

3. ROLE MODELING SELF-CARE

 

There is nothing quite like your teen calling you a hypocrite to squelch even the best teaching moment!  Role modelling the behaviors you want to see in your teens and young adults is perhaps one of the most effective teaching tools for parents.  Parents need to “walk the walk,” not just “talk the talk.”  This means that parents and caregivers need to be mindful of their behaviors and be examples of good self-care.  How are you looking after yourself?  Are you modeling social-distancing?  Can you empathize with your teen who hasn’t seen their friends because you yourself have missed out on unsafe interactions and social engagements? 

 

 

 4. TEACH LIMITS – DON’T JUST IMPOSE THEM

 

Setting limits is most effective when it is a collaborative exercise between you and your teen/young adult.  First, it increases the likelihood of “buy-in” when the teen/young person has been part of the thought process involved in setting a limit.  Secondly, teens can learn how to make boundaries for themselves when they are given the opportunity to practice them in-vivo.    Save those “heavy-handed” moments for when your teens need you to be an excuse for them to save face with their friends!

 

 

I can only imagine that our grown teens and adults will have lots of stories to tell the next generation about 2020.  Some of their stories will remember the losses and sacrifices which were made during this period.  Other stories will be light and humorous – not to mention a vault of funny memes that will be available to look back on.  Whatever their experiences, I hope that our teens and young adults can look back upon this period and remember how much we cared about them and how they grew in resilience, strength and character.

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REFERENCES

 

Ali  M.M., West  K., Teic,  J.L., Lynch,  S., Mutter,  R., Dubenitz,  J.  Utilization of mental health services in educational setting by adolescents in the United States.   J. Sch Health. 2019;89(5):393-401. doi:10.1111/josh.12753

 

American Psychological Association Stress in America: Generation Z. Stress in America™ Survey

https://www.mentalhealthfirstaid.org/wpcontent/uploads/2020/05/031920_tMHFA_GeneralOnePager_v5.pdf (2018).

 

Beaglehole B, Mulder RT, Frampton CM, et al. Psychological distress and psychiatric disorder after natural disasters: systematic review and meta-analysis. Br J Psychiatry. 2018;213:716-722.

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Damour, L. New York Times, March 11, 2020.

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Divecha, D.,  Our Teens Are More Stressed Than Ever: Why, and What Can You Do About It?  https://www.developmentalscience.com/blog/2019/5/7/our-teens-are-more-stressed-than-ever.  May 9, 2019

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Dooley D, Catalano R. The epidemiology of economic stress. American Journal of Community Psychology. 1984;12:387–409. [PubMed] [Google Scholar]

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Erikson, E.H. Identity, Youth, and Crisis, 1968 - books.google.com

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Goewey, D.J. The End of Stress: Four Steps to Rewire Your Brain, 2014

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Kapil, R.  Tips to Help Teens Cope During COVID-19.  https://www.mentalhealthfirstaid.org/2020/04/tips-to-help-teens-cope-during-covid-19/

April 21, 2020

 

Lieberman, J.A. & Olfson, M.  https://www.psychiatrictimes.com/view/meeting-mental-health-challenge-covid-19-pandemic.  April 24, 2020

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Niebuhr, R. the “Serenity Prayer” (1892–1971)

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Travers, M.  No, Extroverts Are Not Suffering More From the Quarantine. New research dispels a popular misconception.  https://www.psychologytoday.com/us/experts/mark-travers-phd Posted May 02, 2020

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